To the Editor.—Farmer and Helwig1 described 11 female patients with cutaneous ciliated cysts in the lower extremities. They quoted only two previously reported cases. The first patient described by Hess in 18902 was a 15-year old-girl with a ciliated cyst situated over the fourth or fifth thoracic vertebra and because of this anatomic situation, the lesion may well have been an ependymal heterotopia. The second patient, whom I described in 1969,3 had exactly the same type of lesion as Farmer and Helwig1 described in their 11 patients.Four additional patients, who were not mentioned by Farmer and Helwig,1 were described by Butterworth et al.4 These patients, aged 15 to 27 years, were all female and had lesions situated in the lower extremities. One of these four noticed an increase in size of the cyst during pregnancy, unlike the one case of Farmer and